Provider Demographics
NPI:1639212822
Name:MURAYAMA, JESSE (DN)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:MURAYAMA
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ATKINSON ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030
Mailing Address - Country:US
Mailing Address - Phone:847-223-2962
Mailing Address - Fax:847-223-2839
Practice Address - Street 1:100 N ATKINSON ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-223-2962
Practice Address - Fax:847-223-2839
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist